Survey of Bacterial Isolates and Their Antimicrobial Susceptibility Patterns from Dogs with Infective Endocarditis.

Infective endocarditis (IE) is a potentially fatal disease in dogs. Limited information exists regarding the characterization of bacterial isolates from dogs with IE. The objective of this study was to describe bacterial isolates associated with IE and their antimicrobial susceptibility patterns. A retrospective analysis of dogs with IE and bacterial isolates was performed, and antimicrobial susceptibility was interpreted using current veterinary cut points where available. The susceptibility rate was assessed for association with survival and previous antimicrobial administration. Fifty-one bacterial isolates were identified from 45 dogs, and 33 had antimicrobial susceptibility performed. Staphylococcus spp. (14/51; 27.5%) was the most common organism. Antimicrobials with the lowest susceptibility rate were ampicillin (19/26; 73%), doxycycline (16/22; 73%), and enrofloxacin (22/29; 76%) with 12/33 (36%) of isolates exhibiting multidrug resistance (MDR). Individual antimicrobial resistances and the MDR rate were not associated with a difference in survival rate. Bacterial isolates from dogs that had received fluoroquinolone antimicrobials in the month before diagnosis had a higher rate of non-intrinsic fluoroquinolones resistance (5/8;62.5%) compared to those that did not receive fluoroquinolones (2/21; 9.5%) (p = 0.03). Antimicrobial resistance and MDR phenotype were common in this study. Culture and antimicrobial susceptibility testing should be pursued in dogs with IE to help guide antimicrobial therapy.

Pertuzumab as second­ or later­line therapy for human epidermal growth factor receptor 2­positive metastatic breast cancer: A clinical experience.

Trastuzumab and pertuzumab with taxane-based chemotherapy are considered the first-line standard therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC). Pertuzumab is also a later-line therapy for mBC in Switzerland, although limited safety and efficacy data are available. The present study assessed the therapeutic regimens, toxicities and clinical outcomes after second- or later-line pertuzumab therapy in patients with mBC who did not receive pertuzumab as a first-line therapy. Physicians from nine major Swiss oncology centers retrospectively completed a questionnaire for each pertuzumab-naive patient who was treated with pertuzumab as a second- or later-line therapy. Of 35 patients with HER2-positive mBC (median age, 49 years; range, 35-87 years), 14 received pertuzumab as a second-line therapy, 6 as a third-line therapy, and 15 as a fourth- or later-line therapy. A total of 20 patients (57%) died during the study period. The median overall survival was 74.2 months (95% confidence interval, 47.6-139.8 months). Grade (G) 3/4 adverse events (AEs) were reported in 14% of patients, with only 1 patient discontinuing therapy due to pertuzumab-related toxicities. The most common AE was fatigue (overall, 46%; G3, 11%). Overall, congestive heart disease occurred in 14% of patients (G3, 6%), nausea in 14% of patients (all G1), and myelosuppression in 12% of patients (G3, 6%). In conclusion, the median overall survival of patients who underwent second- or later-line pertuzumab treatment was similar to that reported for patients who underwent first-line pertuzumab treatment, and the safety profile was acceptable. These data support the use of pertuzumab for second- or later-line therapy when it was not administered as first-line therapy.

Eribulin as first-line treatment in older patients with advanced breast cancer: A multicenter phase II trial [SAKK 25/14].

INTRODUCTION: Standard-dose eribulin mesylate (1.4 mg/m2 d1 + 8) achieves clinical benefit rates of 26%-52% in patients with metastatic breast cancer (mBC). <10% of patients in the registration trial were ≥ 70 years old; dose reductions were common in these older patients. MATERIALS AND METHODS: This single-arm phase II trial explored the efficacy of reduced starting dosing of first-line eribulin at 1 mg/m2 d1 + 8 q3 weeks in patients with mBC aged ≥70 years. The primary endpoint was a disease control rate (DCR) ≥55%. The secondary endpoints were objective response (OR), progression-free survival (PFS), overall survival (OS), and patient-reported neurotoxicity. RESULTS: Overall, 77 patients were accrued; their median age was 76 years and Eastern Cooperative Oncology Group performance status was 0-1 in 90%. The DCR was 40% (90% confidence interval [CI]: 31-50); therefore, the primary endpoint was not reached. The overall response rate was 22% (95%CI: 13-33), median PFS 5.4 months (95%CI: 4.5-7.7), and median OS 16.1 months (95%CI: 13.5-26.9). Dose modifications were necessary in 35% of patients. In nine patients, more than fifteen cycles were given; 48 patients (62%) experienced at least one grade 3 toxicity. Median patient-reported neurotoxicity scores remained stable for at least fifteen cycles. The main reason for treatment discontinuation was disease progression (57%). DISCUSSION: We report the first prospective data on first-line eribulin in older patients. The reduced starting dose of 1.1 mg/m2 was safe, with prolonged treatment and DC achieved in a considerable proportion of patients (but less than the 55% assumed), without cumulative neurotoxicity. The reduced dose was apparently within the range of the minimal effective dose, as shown by the efficacy lack in patients requiring further dose reductions. Thus, our results do not support the approach of a reduced starting dose for older patients.

Visualizing and quantifying the suppressive effects of glucocorticoids on the tadpole immune system in vivo.

A challenging topic in undergraduate physiology courses is the complex interaction between the vertebrate endocrine system and the immune system. There are relatively few established and accessible laboratory exercises available to instructors to help their students gain a working understanding of these interactions. The present laboratory module was developed to show students how glucocorticoid receptor activity can be pharmacologically modulated in Xenopus laevis tadpoles and the resulting effects on thymus gland size visualized and quantified in vivo. After treating young tadpoles with a cortisol receptor agonist (dexamethasone) for 1 wk, students can easily visualize the suppressive effects of glucocorticoids on the intact thymus gland, which shrinks dramatically in size in response to this steroid hormone analog. However, the suppressive effect of dexamethasone is nullified in the presence of the glucocorticoid receptor antagonist RU-486, which powerfully illustrates the specific effects of glucocorticoid receptor inhibition on the immune system. Image analysis and statistics software are used to quantify the effects of glucocorticoid modulation on thymus size.

Are Narrow Focus Exhaustivity Inferences Bayesian Inferences?

In successful communication, the literal meaning of linguistic utterances is often enriched by pragmatic inferences. Part of the pragmatic reasoning underlying such inferences has been successfully modeled as Bayesian goal recognition in the Rational Speech Act (RSA) framework. In this paper, we try to model the interpretation of question-answer sequences with narrow focus in the answer in the RSA framework, thereby exploring the effects of domain size and prior probabilities on interpretation. Should narrow focus exhaustivity inferences be actually based on Bayesian inference involving prior probabilities of states, RSA models should predict a dependency of exhaustivity on these factors. We present experimental data that suggest that interlocutors do not act according to the predictions of the RSA model and that exhaustivity is in fact approximately constant across different domain sizes and priors. The results constitute a conceptual challenge for Bayesian accounts of the underlying pragmatic inferences.

Cell-cell interactions during remodeling of the intestine at metamorphosis in Xenopus laevis.

Amphibian metamorphosis is accompanied by extensive intestinal remodeling. This process, mediated by thyroid hormone (TH) and its nuclear receptors, affects every cell type. Gut remodeling in Xenopus laevis involves epithelial and mesenchymal proliferation, smooth muscle thickening, neuronal aggregation, formation of intestinal folds, and shortening of its length by 75%. Transgenic tadpoles expressing a dominant negative TH receptor (TRDN) controlled by epithelial-, fibroblast-, and muscle-specific gene promoters were studied. TRDN expression in the epithelium caused abnormal development of virtually all cell types, with froglet guts displaying reduced intestinal folds, thin muscle and mesenchyme, absence of neurons, and reduced cell proliferation. TRDN expression in fibroblasts caused abnormal epithelia and mesenchyme development, and expression in muscle produced fewer enteric neurons and a reduced inter-muscular space. Gut shortening was inhibited only when TRDN was expressed in fibroblasts. Gut remodeling results from both cell-autonomous and cell-cell interactions.

Flatfish: an asymmetric perspective on metamorphosis.

The most asymmetrically shaped and behaviorally lateralized of all the vertebrates, the flatfishes are an endless source of fascination to all fortunate enough to study them. Although all vertebrates undergo left-right asymmetric internal organ placement during embryogenesis, flatfish are unusual in that they experience an additional period of postembryonic asymmetric remodeling during metamorphosis, and thus deviate from a bilaterally symmetrical body plan more than other vertebrates. As with amphibian metamorphosis, all the developmental programs of flatfish metamorphosis are ultimately under the control of thyroid hormone. At least one gene pathway involved in embryonic organ lateralization (nodal-lefty-pitx2) is re-expressed in the larval stage during flatfish metamorphosis. Aspects of modern flatfish ontogeny, such as the gradual translocation of one eye to the opposite side of the head and the appearance of key neurocranial elements during metamorphosis, seem to elegantly recapitulate flatfish phylogeny. This chapter highlights the current state of knowledge of the developmental biology of flatfish metamorphosis with emphases on the genetic, morphological, behavioral, and evolutionary origins of flatfish asymmetry.

Selective asymmetry in a conserved forebrain to midbrain projection.

How the left and right sides of the brain acquire anatomical and functional specializations is not well understood. The zebrafish has proven to be a useful model to explore the genetic basis of neuroanatomical asymmetry in the developing forebrain. The dorsal diencephalon or epithalamus consists of the asymmetric pineal complex and adjacent paired nuclei, the left and right medial habenulae, which in zebrafish larvae, exhibit differences in their size, neuropil density and patterns of gene expression. In all vertebrates, axons from the medial habenular nuclei project within a prominent fiber bundle, the fasciculus retroflexus, to a shared midbrain target, the interpeduncular nucleus of the ventral tegmentum. However, in zebrafish, projections from the left habenula innervate the dorsal and ventral regions of the target nucleus, whereas right habenular efferents project only to the ventral region. A similar dorsoventral difference in habenular connectivity is found in another teleost species, the highly derived southern flounder, Paralichthys lethostima. In this flatfish, directional asymmetry of the habenular projection appears to be independent of the left-right morphology and orientation that an individual adopts post-metamorphosis. Comparative anterograde labeling of the brains of salamanders, frogs and mice reveals that axons emanating from the left and right medial habenulae do not project to different domains, but rather, they traverse the target nucleus in a complementary mirror image pattern. Thus, although the habenulo-interpeduncular conduction system is highly conserved in the vertebrate brain, the stereotypic dorsoventral topography of left-right connections appears to be a feature that is specific to teleosts.

Asymmetric craniofacial remodeling and lateralized behavior in larval flatfish.

Flatfishes, such as flounder, are the world's most asymmetric vertebrates. It is unknown if the development of lateralized swimming behavior during metamorphosis is an adaptive response to bilaterally asymmetric eye positioning, or if this results from a vestibular response to thyroid hormone. This study describes larval development in left-sided, right-sided and bilaterally symmetric variants of southern flounder (Paralichthys lethostigma). Behavior and skull asymmetries precede metamorphosis, and the development of lateralized behaviors was independent of eye position in larvae treated with thyroid hormone and in symmetrical variants. Therefore, lateralized behavior is not an adaptive response to eye translocation, but rather must result from changing vestibular responses to thyroid hormone.

Thyroid hormone controls multiple independent programs required for limb development in Xenopus laevis metamorphosis.

Thyroid hormone (TH) is required for limb development in Xenopus laevis. Specific cell types in the growing limb were targeted for expression of a dominant negative form of the TH receptor by sperm-mediated transgenesis. Limb muscle development, the innervation of muscle from the spinal cord, and cartilage growth can be inhibited without affecting patterning of the limb or differentiation of other cell types. Remodeling of the skin occurs late in metamorphosis after the limb has formed. The coordination of these independent programs is affected in part by the control that TH exerts over DNA replication in all cell types of the limb.

Tadpole skin dies autonomously in response to thyroid hormone at metamorphosis.

Transgenic tadpoles that express a dominant negative thyroid hormone (TH) receptor specifically in their skin undergo normal metamorphosis, with one exception: they retain a larval epidermis over the developing adult epithelium. TH-induced death of the tadpole epidermis is inhibited by the dominant negative TH receptor whereas the TH-induced response of the neighboring fibroblasts and the cells that form the adult skin occur normally. Therefore death of the tadpole skin is a direct and cell autonomous target of TH, and its protection has no detectable influence on TH-induced changes of other cell types.

Multiple thyroid hormone-induced muscle growth and death programs during metamorphosis in Xenopus laevis.

Xenopus laevis tadpole tails contain fast muscle fibers oriented in chevrons and two pairs of slow muscle "cords" along the length of the tail. When tail resorption is inhibited by a number of different treatments, fast muscle but not the slow cord muscle still is lost, demonstrating that the fast tail muscle is a direct target of the thyroid hormone-induced death program. Expression of a dominant negative form of the thyroid hormone receptor (TRDNalpha) was restricted to tadpole muscle by means of a muscle-specific promoter. Even though the transgene protects fast tail muscle from thyroid hormone (TH)-induced death, the tail shortens, and the distal muscle chevrons at the tail tip are degraded. This default pathway for muscle death is probably caused by the action of proteolytic enzymes secreted by neighboring fibroblasts. Non-muscle tissues that are sensitive to TH, such as the fibroblasts, are not protected by the transgene when it is expressed solely in muscle. If allowed to develop to metamorphosis, these transgenic animals die at the climax of metamorphosis before tail resorption has begun. Their limbs have very little muscle even though the rest of limb morphology is normal. Thus, fast tail muscle and limb muscle have their own cell autonomous death and growth programs, respectively, that are independent of the fate of the other neighboring cell types. In contrast, death of the slow muscle is controlled by the other cell types of the tail.